Healthcare Provider Details

I. General information

NPI: 1841277928
Provider Name (Legal Business Name): PETER R LEWY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 WILMETTE AVE
WILMETTE IL
60091-2604
US

IV. Provider business mailing address

1144 WILMETTE AVE
WILMETTE IL
60091-2604
US

V. Phone/Fax

Practice location:
  • Phone: 847-256-6480
  • Fax: 847-256-6482
Mailing address:
  • Phone: 847-256-6480
  • Fax: 847-256-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036039917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: